Hostname: page-component-848d4c4894-x24gv Total loading time: 0 Render date: 2024-05-30T08:58:33.929Z Has data issue: false hasContentIssue false
  • English
  • Français

Wound management across Australian and New Zealand pediatric cardiac services: a cross-sectional survey

Published online by Cambridge University Press:  06 November 2023

Jennifer Orchard ,
Jessica Suna ,
Anna Renner ,
Lara Gordon ,
Lianne McCarthy ,
Natasha Pool ,
Mary Tallon  and
Amanda J. Ullman
Jennifer Orchard*
Affiliation:
Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
Jessica Suna
Affiliation:
Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
Anna Renner
Affiliation:
Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
Lara Gordon
Affiliation:
The Children’s Hospital at Westmead, The Sydney Children’s Hospital Network, Sydney, Australia
Lianne McCarthy
Affiliation:
Starship Child Health, Te Toka Tomai, Auckland, New Zealand
Natasha Pool
Affiliation:
Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia
Mary Tallon
Affiliation:
HeartKids Ltd, Parramatta, Australia School of Nursing, Curtin University, Perth, Western Australia Perth Children’s Hospital, Perth, Western Australia
Amanda J. Ullman
Affiliation:
Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, Australia School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia NHMRC Centre for Wiser Wound Care, Griffith University, Brisbane, Australia
*
Corresponding author: J. Orchard; Email: jennifer.orchard@health.qld.gov.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

CHD is associated with considerable burden of care. Up to one-third of babies born with CHD require surgery or intervention during the first year of life with an associated increased risk of surgical site infection. Pediatric wound care is informed largely by adult data, with no national or international guidelines available.

Aim:

To examine pediatric cardiac surgical wound care practices reported by healthcare professionals Australia and New Zealand-wide.

Methods:

A bi-national cross-sectional survey exploring pre-, intra- and post-operative wound practices was distributed using Exponential Non-Discriminative Snowball Sampling. Data were subject to descriptive analysis using SPSS Statistics 22.0.

Findings:

Sixty-eight surveys representing all Australian and New Zealand pediatric cardiac surgical services were analyzed. Most respondents were experienced nurses. Pre-operative care varied greatly in practice and pharmaceutical agents used. Little consistency was reported for intra- and post-operative wound care. Nursing and medical staff shared responsibility for wound care. Wound photography was widely used, but only uploaded to electronic medical records by some.

Discussion:

These results highlight that wound care management is largely informed at an institutional level. The many practices reported are likely to reflect a range of factors including cardiac condition complexity, surgery, prematurity, and the presence of scar tissue. The importance of a research and training program, which is multimodal, available, and reflective, is highlighted.

Conclusion:

These findings call for the establishment of a nurse-led program of research and education. The resultant suite of cardiac wound strategies could offer an effective and consistent pathway forward.

Keywords

Paediatric cardiac surgical wound care practicesCHDmultimodal research and education
Type
Original Article
Information
Cardiology in the Young , First View , pp. 1 - 7
Copyright
© The Author(s), 2023. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Government. National Strategic Action Plan for Childhood Heart Disease. Department of Health, Canberra, 2019.Google Scholar
Australian Institute of Health and Welfare. Congenital Heart Disease in Australia. Australian Government, Canberra, 2019.Google Scholar
Ferencz, C, Rubin, JD, McCarter, RJ, et al. Congenital heart disease: prevalence at livebirth. The Baltimore-Washington infant study. Am J Epidemiol 1985; 121: 31–36.CrossRefGoogle ScholarPubMed
Bratzler, DW, Dellinger, EP, Olsen, KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70: 195–283.CrossRefGoogle ScholarPubMed
Ridderstolpe, L, Gill, H, Granfeldt, H, Ahlfeldt, H, Rutberg, H. Superficial and deep sternal wound complications: incidence, risk factors and mortality. Eur J Cardiothorac Surg 2001; 20: 1168–1175.CrossRefGoogle ScholarPubMed
Sahu, MK, Siddharth, CB, Devagouru, V, et al. Hospital-acquired infection: prevalence and outcome in infants undergoing open heart surgery in the present era. Indian J Crit Care Med 2017; 21: 281–286.Google ScholarPubMed
Braxton, JH, Marrin, CA, McGrath, PD, et al. 10-year follow-up of patients with and without mediastinitis. Semin Thorac Cardiovasc Surg 2004; 16: 70–76.CrossRefGoogle ScholarPubMed
Demmy, TL, Park, SB, Liebler, GA, et al. Recent experience with major sternal wound complications. Ann Thorac Surg 1990; 49: 458–462.CrossRefGoogle ScholarPubMed
Huang, JH, Sunstrom, R, Munar, MY, et al. Are children undergoing cardiac surgery receiving antibiotics at subtherapeutic levels? J Thorac Cardiovasc Surg 2014; 148: 1591–1596.CrossRefGoogle ScholarPubMed
Kreter, B, Woods, M. Antibiotic prophylaxis for cardiothoracic operations. Meta-analysis of thirty years of clinical trials. J Thorac Cardiovasc Surg 1992; 104: 590–599.CrossRefGoogle ScholarPubMed
Sochet, AA, Cartron, AM, Nyhan, A, et al. Surgical site infection after pediatric cardiothoracic surgery. World J Pediatr Congenit Heart Surg 2017; 8: 7–12.CrossRefGoogle ScholarPubMed
Woodward, C, Taylor, R, Son, M, Taeed, R, Husain, SA. Efforts to reduce infections in delayed sternal closure patients: a survey of pediatric practice. World J Pediatr Congenit Heart Surg 2020; 11: 310–315.CrossRefGoogle ScholarPubMed
Woodward, CS, Son, M, Calhoon, J, Michalek, J, Husain, SA. Sternal wound infections in pediatric congenital cardiac surgery: a survey of incidence and preventative practice. Ann Thorac Surg 2011; 91: 799–804.CrossRefGoogle ScholarPubMed
Bannigan, K, Watson, R. Reliability and validity in a nutshell. J Clin Nurs 2009; 18: 3237–3243.CrossRefGoogle Scholar
DeVon, HA, Block, ME, Moyle-Wright, P, et al. A psychometric toolbox for testing validity and reliability. J Nurs Scholash 2007; 39: 155–164.CrossRefGoogle ScholarPubMed
August, D, Ullman, A, Coyer, F. Device related pressure injuries across the critical care lifespan. Nurs Crit Care 2023; 28: 6–8.CrossRefGoogle ScholarPubMed
Prendin, A, Tabacco, B, Fazio, PC, de Barbieri, I. Management of pediatric cardiac surgery wound: a literature review. Acta Biomedica Atenei Parmensis 2021; 92: e2021203.Google ScholarPubMed
Jha, NK, Shafique, M, Thomas, R, Pangilinan Cruz, S, Tariq, G, Kiraly, L. The sternal wound management in pediatric cardiac surgical patients: implementation of wound care pathways incorporating principles of wound bed preparation paradigm and early-advanced therapy. Adv Skin Wound Care 2022; 35: 00–00.Google Scholar
August, D, van der Vis, KM, New, K. Conceptualising skin development diagrammatically from foetal and neonatal scientific evidence. J Neonatal Nurs 2019; 25: 311–314.CrossRefGoogle Scholar
Stefanko, NS, Drolet, BA. Subcutaneous fat necrosis of the newborn and associated hypercalcemia: a systematic review of the literature. Pediatr Dermatol 2019; 36: 24–30.CrossRefGoogle ScholarPubMed
Shiferaw, A, Mola, S, Gashaw, A, Sintayehu, A. Evidence-based practical guideline for procedural pain management and sedation for burn pediatrics patients undergoing wound care procedures. Ann Med Surg 2022; 83: 104756.CrossRefGoogle ScholarPubMed
Supplementary material: File

Orchard et al. supplementary material
Download undefined(File)
File 141.6 KB